Rheumatology

Question 1

signs of active synovitis in the small joints of the hand

Answer 1

JEBUS (signs of active synovitis in the small joints of the hand)

Joint stiffness
Effusion
Bogginess
Ulnar-styloid tenderness
Stress tenderness

Question 2

causes of proximal muscle weakness

Answer 2

PACE PODS (causes of proximal muscle weakness)
Polymyositis
Alcohol
Connective tissue diseases
Endocrine (thyroid – hypo?, Cushing)

Periodic paralysis
Osteomalacia
Drugs (statins, steroids)
Sarcoid

Question 3

criteria of SLE

Answer 3

RASH ON MAIDS (criteria of SLE)

R: Renal 6 classes of GN (class 1-4 on severity, 3-4 more proliferative, 5 membranous nephritis, 6 end stage) – refer to American College of Rheumatologist guide on lupus nephritis
A: ANA positive
S: Serositis (pericarditis, pleuritic)
H: Hematological

O: Oral Ulcers (and nasal)
N: Neurological changes

M: Malar rash (usually on maids) 
A: Arthropathies (non-erosive, > 2)
I: Immune disorder (dsDNA)
D: Discoid rash 
S: Sunlight sensitivity (photosensitivity)

For more details on the criteria, refer to the American College of Rheumatology Guidelines that is attached in the folder.

You need 4/11 to diagnose SLE (even then, it’s only 95% specific and 85% sensitive. Also, you can diagnose SLE with < 4)

Question 4

approach to rheumatology patient

Answer 4

PISA classification (approach to rheumatology)

Poly, oligo, mono
Inflamammatory, anti-inflammatory
Symmetrical
Acute, chronic

Question 5

Features of rheumatoid arthritis

Answer 5

Features of rheumatoid arthritis
Mnemonic: RHEUMATISM
R Rheumatoid factor (RF) +ve in 80%/Radial deviation of wrist
H HLA-DR1 and DR-4
E ESR/Extra-articular features (restrictive lung disease, subcutaneous nodules)
U Ulnar deviation of fingers
M Morning stiffness/MCP+PIP joint swelling
A Ankylosis/Atlanto–axial joint subluxation/Autoimmune/ANA +ve in 30%
T T-cells (CD4)/TNF
I Inflammatory synovial tissue (pannus)/IL-1
S Swan-neck deformity, Boutonniere deformity, Z-deformity of thumb
M Muscle wastage of small muscles of hand

Question 6

DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

Answer 6

DMARDs (Disease-Modifying Anti-Rheumatic Drugs)  
Mnemonic: Most Sufferers Can Get Appropriate Pain Control  
M  	Methotrexate  
S  	Sulfasalazine  
C  	Ciclosporin  
G  	Gold  
A  	Azathioprine  
P  	Penicillamine  
C  	HydroxyChloroquine

Question 7

Causes of joint pain

Answer 7

Causes of joint pain
Mnemonic: ARTHRITIS  
A  	Arthritis – rheumatoid or osteoarthritis  
R  	Reactive arthritides  
T  	Tendon/muscle damage  
H  	Hyperuricaemia; gout  
R 	Referred pain  
I  	AutoImmune, eg connective tissue disease – systemic sclerosis, SLE  
T  	Tumour  
I 	Ischaemia  
S  	Sepsis/Spondyloarthritides

Question 8

Features of ankylosing spondylitis

Answer 8

Features of ankylosing spondylitis
Mnemonic: SPINAL
S Sacroiliac and low back pain
P Pleuritic chest pain
I Inherited gene marker: HLA-B27 (>90% HLA-B27 +ve, general population frequency – 8%)
N Neck hyperextension – question mark posture
A Arthritic symptoms in peripheries (asymmetrical)
L Loss of spinal movement which is progressive

Question 9

Components of CREST syndrome

Answer 9

Components of CREST syndrome  
Mnemonic: CREST  
C  	Calcinosis  
R  	Raynaudʼs phenomenon  
E  	OEsophageal dysmotility  
S	Sclerodactyly  
T	Telangiectasia

Question 10

features of osteoarthritis

Answer 10

LOSS (features of osteoarthritis)

Loss of joint space (eccentral)
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 11

features of rheumatoid arthritis

Answer 11

LOSE (features of rheumatoid arthritis)

Loss of joint space (concentric)
Osteopenia
Soft tissue swelling/subluxation/gross deformity
Erosions – juxta-articular erosions